Identifying pain management in chronic pain patients with secure attachment style: A qualitative study

Document Type : Research Paper

Authors

Shakhes Pajouh Research Institute, Health Management Research Group, Isfahan University, Iran

Abstract

Introduction: Chronic pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage which persists for a minimum of six months. Attachment theory has been used to explain how individuals relate to each other during moments of pain. The purpose of this research is to identify pain management in people with chronic pain and secure attachment style.
 Materials and Methods: This study was conducted at the Pain and Neurology Clinic of the University Kebangsaan Malaysia Medical Centre from August 2009 to February 2010. 22 female patients with chronic pain were interviewed, using open-ended semi-structured interview guide in English language. Data were analyzed using Interpretative Phenomenological Analysis (IPA).
Results: Through IPA technique, ideal support themes were identified with five subthemes; emotional dependence on family, emotional closeness to friends, independence and self-sufficiency, preference to be with family, and need for support.
Conclusion: Chronic pain patients reported that they needed to be emotionally close with their families during moments of pain as a coping style to soothe their pain through increased intimacy and closeness. Prolonged duration of pain led them to change their everyday life activities and increased the need for close relationships. Patients with chronic pain may have different forms of coping style.  Chronic pain suppressed close relationship which may arise between patients and their family during moments of pain. 

Keywords


1.Cardosa MS. Pain management: Trends and challenges. Med J Malaysia 2006; 61: 139-40.
2.Delilkan AE. Pain management and the role of pain clinics in Malaysia: Is there a place for alternative medicine in pain clinics? Med J Malaysia 1998; 53(3): 201-3.
3.Sessle BJ. Pain management challenges: Research, access, costs, education and public awareness. J Pain Manag 2011; 1(1): 25-9.
4.Catalano EM, Hardin KN, Allen RW. The chronic pain control workbook: a step by step guide for coping with and overcoming pain. Oakland, CA: New Harbinger; 1996: 141-58.
5.Erickson B. Depression, anxiety, and substance use disorder in chronic pain. Tech Reg Anesth Pain Manag 2005; 9: 200-3.

6.Hunfeld AM, Perquin CW, Duivenvoorden HJ, Hazebroek-Kampschreur AM, Passchier J, Suijlekom-Smit L, et al. Chronic pain and its impact on quality of life in adolescents and their families. J Pediatr Psychol 2001; 26(3): 145-53.

7.Ramage-Morin RL. Chronic pain in Canadian seniors. Health Rep 2008; 19: 37-52.
8.Gamsa A. The role of psychological factors in chronic pain. A critical appraisal. J Pain 1994; 57: 13-29.
9.Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev 2003; 40(5): 397-406.
10.Meredith P, Strong J, Feeney JA. Adult attachment, anxiety, pain self- efficacy as predictors of pain intensity and disability. J Pain 2006; 123: 146-54.
11.Mikail SF, Henderson PR, Tasca GA. An interpersonal based model of chronic pain: An application of attachment theory. Clin Psychol Rev 1994; 14(1): l-16.
12.CiechanowskiP, Sullivan M, Jensen M, Romano J, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain 2003; 104(3): 627-37. 
13.Bowlby J. A secure base: Clinical application of attachment theory New York: Routledge; 1988: 29-138
14.Meredith P, Strong, Feeney JA. Adult attachment variables predict depression before and after treatment for chronic pain. Eur J Pain 2007; 11: 164-70.
15.Meredith P, Ownsworth T, Strong J. A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clin Psychol Rev 2008; 28: 407-29.
16.Vasudevan S. Guidelines for the assessment and management of chronic pain. Wis Med J 2010; 103(3):15.
17.Merskey H, Bogduk N. Classification of chronic pain: Description of chronic pain syndromes and definitions of pain terms. Seattle: IASP; 1994: 209-14.
18.Ng KF, Tsui SL, Chan WS. Prevalence of chronic pain in Hong Kong adults. Hong Kong Med J 2007; 13(2): 28-9.
19.Ryan CG, Gray HG, Newton M, Granat MH. The relationship between psychological distress and free-living physical activity in individuals with chronic low back pain. Man Ther2010; 15: 185-9.
20.Smith A. Intimacy and family relationships of women with chronic pain. Pain Manag Nurs 2003; 4(3): 134-42.
21.Davies  KA, McFarlane GJ, McBeth J,Morriss R, Dickens C. Insecure attachment style is associated with chronic widespread pain.Pain 2009; 143(3): 200-5.
22.McDonald G, Kingsbury R. Does physical pain augment anxious attachment? J Soc Pers Relat 2006; 23: 291.
23.Mikulincer M, Shaver PR. The attachment behavioral system in adulthood: Activation, psychodynamics and interpersonal processes. Adv Exp Soc Psychol 2003; 35: 53-152. 
24.Sperling MB, Berman WH. Attachment in adults: Clinical and developmental perspectives. New York: Guilford; 1994: 129.
25.Hazan C, Shaver P. Romantic love conceptualized as an attachment process. J Pers Soc Psychol 1987; 52: 511-24.
26.Bowlby J. Separation: Anxiety and anger, attachment and loss.  New York: Hogarth; 1973.
27.Bartholomew K, Horowitz LM. Attachment styles among young adults: A test of four-category model. J Pers Soc Psychol1991; 61(2): 226-44.
28.Mikulincer M, ShaverPR.Attachment in adulthood: Structure, dynamic and change. New York: Guilford;2007: 13-377.
29.Carter S, Handerson L. Approaches to qualitative data collection in social science. In: Bowling A, Ebrahim S. (editors). Handbook of health research methodology. Berkshire: Open University; 2005: 226-7.
30.Mason M. Sample size and saturation in PhD using qualitative interviews. Forum Qual Soc Res 2010; 11(3): Art. 8. Available from: URL; http://www.qualitative-research.net/index.php/fqs/article/view/1428/3027
31.Smith JA, Jarman M, Osborn M. Doing interpretative phenomenological analysis. In: Murray M, Chamberlain K. (editors). Qualitative health psychology: Theories and method. London: Sage; 1999: 218-40.
32.Smith JA, Osborn M. The fearfulness of chronic pain and the centrality of the therapeutic relationship in containing it: An interpretative phenomenological analysis. Qual Res Psychol 2008; 5(4): 276-88.
33.Chapman A, Smith J. Interpretative phenomenological analysis and the new genetics. J Health Psychol 2002; 7(2): 125-30.
34.Mikulincer M, Shaver PR. Attachment theory and emotions in close relationships: Exploring the attachment-related dynamics of emotional reactions to relational events. Pers Relat 2005; 12; 149-68.
35.Altin M, Terzi S. How does attachment styles relate to intimate relationship to aggravate the depressive symptoms. Procedia Soc Behav Sci 2010; 2: 1008-15.
36.Armsden, G, Greenberg M J. The inventory of parent and peer attachment: Relationship to well-being in adolescence. J Youth Adolesc 1987; 16(5): 427-57.
37.Simpson HB, Neria Y, Lewis-Fernez R, Schneier F. Anxiety disorders: Theory, research and clinical perspectives. United Kingdom: Cambridge; 2010: 234.
38.Meredith P, Strong J, Feeney JA. Adult attachment, anxiety, pain self-efficacy as predictors of pain intensity and disability. J Pain 2006; 123: 146-54.
39.Kerns R. Otis JD. Family therapy for persons experiencing pain: Evidence for its effectiveness. Seminars in pain medicine 2003; 1(2): 79-89.
Hildebrandt J. Prediction of psychosocial factors by pain drawing in patients with chronic back pain. Pain Med 2014; 15: 1067-9.